Arkansas' Medicaid Experiment

While all the hootin' and hollerin' today is going to be about the administration'sextending the delay of the Affordable Care Act's employer mandate, in which we will hear Republicans cry that the president is acting "lawlessly" by delaying a portion of a law they hate anyway, it's best to look down in Arkansas, if you want to see what's really behind it all.

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But just as the idea is catching fire in other states with Republican or divided leadership - Iowa has adopted a version of the plan, and New Hampshire, Pennsylvania, Utah and other states are exploring similar avenues - Arkansas may abruptly reverse course, potentially leaving the 83,000 people who have signed up so far without insurance as soon as July 1. Facing pressure from conservative challengers in the May primary, several Republicans who supported the plan last year are now considering switching their vote when the Legislature votes to reauthorize its financing, possibly as soon as next week. The defection of just one Republican could kill the program, state officials said.

If you're keeping score at home, with the cooperation of a Democratic governor, Republicans in Arkansas found a way to tinker with the Medicaid provisions in such a way that wingnuts in many states adopted it as their own. Once 83,000 Arkansans actually signed up for the program, the wingnuttier wingnuts in Arkansas politics lost their shit entirely. The relatively sane wingnuts may be chickening out, and so there we are.

State Representative Nate Bell, a Republican who voted against the private option last year, said that while he would ideally like the program to "go away," he might be inclined to support refunding it if some changes were made."We're going to have to look at them having more skin in the game," he said of the private option enrollees.

Ah, it's always nice to find the tell. This isn't about the Kenyan Usurper any more, and it's not about federalism, or about the dead hand of Big Government, and it's not about a peckerwood view of the Constitution that should have died with Alexander Hamilton Stephens. This is where the conservative base is now. This is now about punishing the poor, or the nearly poor, or the people who could end up being poor.This is about being mean. The reason there is fury on the Tea Party right over this issue is because the Arkansas plan works reasonably well. The fact that people are getting help is the only basis for what appears to the sane among us to be disproportionate anger.

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We have seen it in the fight over extending unemployment insurance, and in the recent derpfest concerning the CBO report on the ACA. The attitude toward anyone who might be considering utilizing what little bits of the safety net are left is one of naked public contempt. Take some help, and smug pundits will call you lazy. They will tell you that your life is not yet hard enough, that suffering is redemptive, and that you don't yet have enough "skin in the game," as though most of them ever have played the game at all, let alone had any skin in it. The conservative side of the argument has been rendered by pressure into a diamond-hard chunk of pure cruelty. And they are proud of it.

(And Nate Bell up there? The skin-in-the-game dude? He happens to be the unmitigated asshole who Tweeted in the immediate aftermath of the Boston Marathon bombing that he wondered, "how many Boston liberals spent the night cowering in their homes wishing they had an AR-15 with a hi-capacity magazine?" Facing national opprobrium, Nate then cobbled together the mother of all hey-the-Internet-how-does-it-work? bullshit alibis: "I don't regret the content as much as I regret the timing...I really didn't think about it going to Boston and was generally expressing my personal view of how I would have felt in that situation myself." In short, fk this shoeless meat suit, is all's I'm saying.)

There is no reason for any Republican to be opposed to what Arkansas is trying to do here, unless you simply believe that there are some people to whom health-insurance ought to remain an aspirational luxury. Politicians increasingly have become emboldened to say so. That puts the burden on the rest of us to decide what sort of country this ought to be.

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